How to Improve Egg Quality

This article focuses on the importance of the quality of your oocytes (immature eggs) and your ova (mature eggs) in your ability to conceive.

How to Improve Egg/Oocyte Quality

As a woman, you were born with all the oocytes that you will ever have—all the potential eggs that you will ever produce. As you age, all the cells in your body start to show damage, and your eggs are no exception. Older women tend to produce less viable eggs. The environment in which your oocytes mature into ova can be modified through diet and lifestyle factors. Optimizing the nutrients that are in your follicular fluid, surrounding your developing eggs, will have a positive impact on the health of your eggs. It takes about three months for a developing egg to progress from its primordial cell state to the point of ovulation. Thus, you should use this time to make your internal environment as healthy as possible to encourage and enhance healthy egg development.

This article will cover the following topics as guidance for optimizing your egg quality:

· Testing for egg quality

· Health of mitochondria

· Immune function

· Free-radical status of follicular fluid

· Nutrients and supplements that positively impact egg quality

Testing for Egg Quality

There are a few tests we can look up to give us an idea about potential quality and quantity of our eggs but until you either achieve a pregnancy and birth a healthy baby or go through an IVF retrieval we can’t say for sure what the quality of women’s eggs are.

If you visit your health professional, you will usually have 2 hormones looked at on day 3 of your menstrual cycle FSH and estrogen.

FSH is a hormone that is important to stimulate the development of your follicles. It becomes very high when you enter menopause, and we can sometimes see elevated levels in the perimenopause stage. So, if your FSH comes back elevated this is something you will need to discuss with your health professional.

Estrogen is necessary to help stimulate development of your follicles. It can be low or supressed in women with a condition called polycystic ovarian syndrome which can result in immature eggs. There are other conditions that can also cause a low level and if that is happening for you generally it will be recommended to use an estrogen supportive medication during your follicular phase to help stimulate the development of your eggs.

AMH is a hormone that is secreted by your primordial follicles (eggs that are not developing yet). This number can be used to help guide the number of stimulant medications that will be needed during an IVF cycle. Often if this number comes back low women will panic that they will not be able to achieve a pregnancy. This value being low does indicate a lower amount of reserve of eggs, but this doesn’t speak to the quality of the eggs being developed. If your AMH is low, it is important to support your egg quality doing the things spoken about in this section. AMH will often be high in women with PCOS, so these women also need to pay more attention to their egg quality as often their eggs are not maturing enough to ovulate.

Body Systems

There are three body systems that are worth focusing on regarding the health and quality of a woman’s oocytes and ova. These systems involve the mitochondria, immune function, and free radicals in follicular fluid.

1. Mitochondria are organelles that are found in every cell of the body. Egg cells contain a high concentration of mitochondria. These organelles produce energy for your cells, allowing the cells to function efficiently. As we age and as we are increasingly exposed to toxins, our mitochondria become less efficient, and they produce less energy. Insufficient energy production can have a negative impact on the body’s ability to detoxify itself and protect its DNA (deoxyribonucleic acid, the molecule that makes up genes).

Mitochondria are very susceptible to toxins, which is one reason that toxic substances may play a huge role in a woman’s fertility status. It is possible that toxicity, which is not routinely evaluated, is responsible for some cases of unexplained infertility. We will cover this topic in more detail in another section on – The Role of Hormone-Disrupting Toxins in Fertility.

2. Cells of the immune system secrete an enzyme called myeloperoxidase (MPO). This enzyme is found in higher levels when there is severe inflammation, and it has been directly linked to poor egg quality and poor reproductive outcomes. This is one of the reasons that chronic inflammation and autoimmune conditions, such as Hashimoto’s thyroiditis, can play big roles in infertility.

The immune system has two main, general types of cells—T cells and B cells. Studies have shown that many patients with endometriosis have low numbers of a type of T cell called T regulatory cells. Somewhere between 25 percent and 50 percent of women with infertility have endometriosis. The exact percentage is uncertain because endometriosis often goes undiagnosed. Whatever the percentage, immune imbalance is clearly relevant to a considerable number of couples.

3. Free radicals can arise in the body through normal detoxification and metabolic processes. They can also enter the body as toxins from the air or the water and food you consume. If your body doesn’t have enough resources to neutralize the free radicals, they can cause damage to any of the cells in the body. When free radicals are found at elevated levels in the follicular fluid, which surrounds your developing eggs, they can damage or negatively impact your egg quality.

Nutrients and Supplements

There are several nutrients that are beneficial to egg quality. Many dietary considerations that can affect egg cells and fertility have previously been discussed in this book. However, if you are over age 35 or have had failed IVF cycles because of poor egg quality, you may benefit from certain supplements.

Laboratory research and clinical findings indicate that certain nutrients play roles in improving the quality of your eggs through mechanisms involving mitochondrial function, immune function, and/or free-radical status. These nutrients, available as supplements, are described in the following text, along with research findings about them. If you are interested in reading more details on this research, please refer to the cited references. You do not need to add all of these substances to your routine. However, I want to bring them to your attention so that you are aware of the variety of nutrients available for improving egg quality, depending on your individual situation.

Myo-inositol

Myo-inositol is in the B vitamin family. It forms part of your cell membrane and is involved in sugar and hormonal regulation. It is also important in fertility, because it enhances the development of mature eggs and improves the chances of egg fertilization. Myo-inositol concentrates in the follicular fluid, and there is a direct relationship between its concentration and egg quality. Its role has been examined in multiple studies of women with fertility concerns. One study correlated intake of myo-inositol with improvement in the following areas:

- Increased clinical pregnancy rates

- Improved number of high-quality eggs

- Higher number of retrieved eggs

- Decrease in number of immature eggs

The ideal dose of myo-inositol found in the studies was between 1 and 4 g/day. In addition, clinical trials using myo-inositol in women with PCOS showed regular ovulation in women who

had not previously ovulated. In most studies of women with PCOS, a dose of 4 g/day was found to be optimal.

Melatonin

Melatonin, a hormone secreted by the pineal gland in the brain, is best known for its impact on promoting sleep. Melatonin also acts as an antioxidant, reducing the oxidative stress on tissue caused by free radicals. It naturally increases during ovulation to help protect the eggs.

In addition, melatonin plays an important role in egg maturation. Studies have found that supplements of low-dose melatonin (1-3 mg) enhanced egg maturation. Both laboratory and clinical studies have demonstrated that melatonin can improve the health of eggs and embryos.

Studies investigating the combination of melatonin and myo-inositol have documented improvements in egg and embryo quality, as well as in other variables. The combination was shown to reduce the adverse effects (side effects) associated with such medicated procedures as IVF. This is especially important for women with PCOS, whose cycles tend to get hyper-stimulated in IVF.

Alpha-Lipoic Acid

Alpha-lipoic acid (ALA) is a powerful antioxidant. Its effects, in combination with those of myo-inositol, have been studied in women with PCOS who were undergoing IVF. The data suggested that the combination helped to improve reproductive outcomes, as well as metabolism in general. Researchers found that after three months, the combination of ALA and myo-inositol led to an improvement in egg quality. The data provided support for the use of this long-term combination in the prevention of PCOS.

Coenzyme Q10

Coenzyme Q10 (CoQ10) is a naturally occurring antioxidant made by your body. This antioxidant is important for mitochondrial health, which, in turn, is important for fertility. As you age, there is a decline in function of the enzymes that make CoQ10. This can be associated with fertility problems. In studies of lab animals with poor mitochondrial function, administration of CoQ10 prevented premature ovarian failure. These results suggested that impaired mitochondrial performance caused by low CoQ10 availability may contribute to age-associated egg deficits and infertility.

Another study investigated the combination of 60 mg of CoQ10 daily, in combination with a common fertility medication called clomiphene citrate. The investigators concluded that the

combination improved ovulation cycles and clinical pregnancies, compared with the use of clomiphene alone. The typical dose of CoQ10, that has been found to aid fertility, is 200 to 600 mg/day.

N-acetylcysteine and L-carnitine

N-acetylcysteine (NAC) is an amino-acid building block for an antioxidant made in the liver called glutathione. Nutritional support for glutathione production will help reduce the amount of damage caused by free radicals.

One study examined the use of NAC, metformin, or a combination of both for women with PCOS who were undergoing intracytoplasmic sperm injections (ICSI). The women in the study received NAC (600 mg three times per day), metformin (1500 mg/day), a combination of both, or a placebo for six weeks. Their oocytes were then retrieved for analysis. Results showed that the number of immature and abnormal oocytes decreased significantly in the NAC group, while the number of good-quality embryos was higher in the NAC group, compared to the placebo group. The researchers concluded that NAC improves the quality of oocytes and embryos, making it a viable alternative to metformin.

Another study looked at the use of NAC in combination with an amino acid called L-carnitine to prevent DNA damage in the eggs of infertile women with mild endometriosis. The researchers found that the use of NAC and L-carnitine together can prevent the egg damage that is caused by free radicals. L-carnitine benefits mitochondrial function by transporting fuel, in the form of fatty acids, from the bloodstream to the mitochondria. If mitochondria don’t receive enough fatty acids, they are unable to produce sufficient energy for cells to function optimally. L-carnitine is also an important consideration if you are supplementing with CoQ10, because CoQ10 can’t get into the mitochondria to do its work if you are deficient in L-carnitine. L-carnitine is found in animal protein sources. If you are a vegetarian or taking CoQ10 in doses higher then 200 mg, it is best to add supplemental L-carnitine to ensure that you derive the maximum beneficial effects from CoQ10. L-carnitine should be dosed between 1,000 and 2,000 mg/day.

Vitamins C and E

Vitamins C and E are both antioxidants that can help to clear potentially damaging free radicals from the follicular fluid. Vitamin E also assists in thickening the uterine lining by encouraging more blood flow. These two vitamins can be found in good-quality prenatal supplements, as well as in diets rich in fruits and vegetables. Vitamin E occurs in highest amounts in foods such as avocados, tomatoes, wheat germ, and unrefined vegetable oils. If your diet is not providing enough vitamin E, try using the mixed tocopherol supplement form, up to 400IU/day. Vitamin C supplements should usually be dosed at 1-2 g/day.

Additional Notes

I have had a number of patients over the years who were struggling with recurrent miscarriages or failed IVF attempts. After supplementing with various combinations of the nutrients discussed in this chapter, they went on to have healthy pregnancies and healthy babies. I realize that this section presents a wealth of information about several studies and their findings on supplements. If you are left feeling overwhelmed and still have questions about supplements, please reach out for a consult or consul with your health professional.

If you haven’t yet been diagnosed with a specific fertility condition, the most important area to focus on would be your mitochondrial health. This would mainly involve supplementing with CoQ10, L-carnitine, NAC, and ALA. Remember that a baby receives all its mitochondria from the mother’s egg—and none from the sperm. The health of the mother’s mitochondria is extremely important. Deficits in mitochondrial function have been linked to a host of health concerns, including fibromyalgia, chronic fatigue, autism spectrum disorder, depression, anxiety, cancer, and heart disease. The healthier you can make your mitochondria as a potential mother, the better it will be for both your health and that of your future children.

Assignments

If you are under age 35 and preparing for a healthy pregnancy, you may not need to add any supplemental support for egg quality. But if you are over age 35, or if you have been having difficulty conceiving, review the information in this section and consider adding the discussed supplements to support healthy egg development. Discuss this issue with your healthcare provider.

Medical Disclaimer:

The information provided in this blog is intended for general informational purposes only and should not be considered as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider or qualified medical professional with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this blog.